We have yet to understand the impact of covert racism and misogyny on the mental health of Canadian citizens, particularly “ethnic” women. However eager they are to contribute to society, however skilled they may be, they face a unique combination of social isolation and career limitations that can trigger illness.

My personal story perhaps speaks to many women from ethnic backgrounds in Ontario and all over Canada. After all, mental illness accounts for about 10 per cent of the burden of disease in Ontario, yet receives just seven per cent of healthcare dollars. Relative to this burden, estimates show that it is underfunded by about $1.5 billion.

My journey to the depths of despair began somewhere around 2014, when after several years of untreated, chronic depression, I developed psychosis. I remember it as the “terror.” I lived alone, had no family in Canada (although I was born in Sherbrooke, Quebec) and had a precarious job as a freelance writer-editor. Somewhere along the way, I thought moving to Toronto might help, but that turned out to be a disaster as well.

The terror began when my editor at a national publication was promoted, and I could no longer expect regular work. The $250 dollars I received from them every month was significant. I made $500-600 a month in total, if I was lucky; I had looked for over a year for more secure and lucrative employment, to no avail.

But the terror I felt was, I realize, largely social. I feared marginalization more than I feared hunger. My former editor had been an encouraging man, one who made me feel valued as a writer. When I no longer had that monthly job, it was as though my only railing on a cliff fell away. I had already questioned my worth to myself, and the answer was now confirmed by the outside world. What value was there to me now? It was as though I had seized to exist.

[quote align="center" color="#999999"]39% of Ontario workers indicate that they would not tell their managers if they were experiencing a mental health problem.-Centre for Mental Health and Addiction[/quote]

After this, the terror came upon me, sudden and all-encompassing. Public Health Ontario estimates the disease burden of mental health at 1.5 times greater than that of all cancers put together and I was feeling every bit.

Finding a safe place

I lived in a sort of dormitory house near the University of Toronto, on Madison, a Victorian “bay-and-gable” mansion that had been cut into rickety, rented rooms. We did not have a personal letter box. Our letters were placed on a table near the entrance. I noticed my bank had not sent me the last monthly statement. I became certain my next-door neighbour, a young red-headed man who seemed to be in his room all the time, had stolen it. My problems began to proliferate. I could not find a toenail-clipper, and this only confirmed my suspicions about my neighbour; then I discovered I could not find an old sweater and a journal, and became convinced he had taken these too.

Around that time, I began to smell a strange odour. I thought it might be a noxious drug seeping from his room, but I could not identify it. At night I huddled under my comforter, hoping to protect my lungs from the fumes. As I heard my neighbour moving about restlessly at night, I imagined he was only waiting to do me harm. I also began to think I was being followed, by my neighbours or perhaps by the then-conservative government, whom I thought might have started tracking my strong political beliefs. I began to fret about being anywhere alone, especially in my room. I walked around the city and spent as much time in cafés and parks, as the homeless do. I was unable to sleep at night.

One night, convinced I was under imminent threat — for my neighbour seemed to have banged against my door— I fled the house and called the police. Little need be said about the fiasco that followed, except that one short, tired, blond sergeant shouted at me, and suggested to her two constables, one of Asian origin and one South Asian, that I might be drunk. (I did not drink.)

They had come up to the room with me, and had tried to stir up my neighbour, but he did not answer. At first, they listened to my story. After I told them about the possibility of my neighbour having made a wax key to break into my room, they lost patience. The sergeant threatened to have me charged. I still remember that she kept telling her colleagues, “After all, it’s not as though she works in an office!” My desk, laptop, books, and papers, which were before her, had no significance. I was illegitimate in her eyes because I did not work in an “office.”

The next morning I promptly moved into the Holiday Inn nearby. I called several women’s shelters around town. The sympathetic co-ordinators pointed out that their beds were full. The only one available was too far away, in another borough.

There was no one in the country of my birth for me to turn to. I had, over the previous years, alienated many people from my life. I had lost faith in the Montreal arts community I had worked in for eight years. I had developed an aversion to what I saw as its insular, largely white milieu, and sensed it could only abuse me. This sense, extreme as it was, was rooted in reality.

Overworked and under-paid

My depression had started a couple of years back, after I had left a debilitating job as an Editor and Executive Director of a well-known Montreal publication. The job, I think in retrospect, had been one often taken by women and minorities. It had been given an inflated title, but left one overworked and under-paid. The board of the organization that ran it was composed of local publishers, mainly old, male and white, who had created it as a para-governmental agency. With federal and provincial grants, they had created jobs that the government deemed necessary but refused to do itself or pay for adequately. I had made $18 an hour, a third of what I had made when working for the government a few years before. I had been paid for 30 hours a week, but worked 60.

For almost two years I had worked around the clock. My health had rapidly deteriorated. My employers had been unhelpful and unfriendly. They had rarely responded to my emails when I required information or a signature, and I often had to travel the city to find them. In spite of my difficulties, I had increased the budget and improved the magazine of the organization. Yet I had been invariably criticized by the board. I had begun to cry every night, and occasionally dreamt of suicide. My social skills had become jagged, unreliable. I had snapped at colleagues and clients. I had met a therapist, a European woman, to whom I did not mention my thoughts of suicide. She had suggested I quit my job. I had eventually fought with my board and resigned in a fit of anger, without first securing another job.

After this, I felt hopeless. Each time my mind turned to the people who shared my environment, my heart grew heavy. I could not help brooding on the daily racial slights I endured within an overwhelmingly white community: one well known director, introduced to me, turned away without speaking to me and asked the person introducing me whether I was her “bookkeeper”; that person was someone with whom I shared a large space, and who suggested to me, since I disliked using the air-conditioner in the summer, that my ethnicity made it easier for me to bear the heat. These “micro-aggressions” were little in themselves, but together, happening regularly, as I grew more depressed, they further intensified my sense of alienation.

I had enough money to isolate myself and devote myself to my own reading and writing. When the money began to run out, I made the huge leap to Toronto, where I could start afresh. It was a disastrous decision.

After two days in the Holiday Inn near the Madison house, feeling unsafe, I relocated to an International hostel in Kensington. My terror was so great now that I prepared to fly to Kolkata, India, where I had inherited a house, and would be surrounded by people familiar to me, of my own origin. One day, I spotted a red-headed panhandler near the hostel who looked eerily like my former next-door neighbour; seeing him triggered both my sense of alienation and intense fear of poverty. Inevitably, I felt the need to leave the hostel.

Identifying the Problem

I stayed, during these three weeks of terror, in five hotels. They cost me roughly $10,000 and I received no security from them; each successive place of sanctuary turned into a house of horror. I must have contacted the police five times, expressing my fears. I tried to tell many people about the “drugs” I could smell in my rooms — from policemen to maids to night-managers. But they smelt nothing and were puzzled that I could not specify what I smelt. Only one person told me I should see a doctor. A young, Asian constable in a police station I had run to one night, he said, “All I’m saying is that you should see your family doctor. Because if you are mentally ill, you will be the last person to know.”

I went to a hospital eventually, because I was so anxious I felt I could hardly breathe. The nurse suspected my illness, and asked if I saw things that others didn't see; I said no, for I smelt things others didn’t smell. The medics performed a brain CT on me. It was normal, and I was sent back to my hotel.

I was bitter. I felt I was being forced to flee the country of my birth, and somewhere in my pent-up mind I thought this was because I was a social threat. This happened to be somewhat true, but not in the way my sickness told me it was. Simply put, as a brown, thinking, writing woman, I was negligible in the society I had been born in. Its various attacks on my mind, from micro-aggression to economic hardship to isolation, caused my mental illness and my ejection from that society.

(*For those living in Ontario, the Mental Health Helpline is a free, confidential live service that is available 24/7 to provide callers with information about mental health services in this Province.)

Aparna Sanyal is a writer and journalist who has worked with the Globe and Mail, the Gazette, the Montreal Review of Books, and Rover. She has been an advocate of mental health awareness and is presently pursuing a Master’s degree in English at McGill University. This piece is part of the "Ethnic Women as Active Participants in Ontario" series.

As a child, it wasn’t unusual for Ann Y.K. Choi to be at work behind the counter of her family’s convenience store in Toronto. She and her two brothers were expected to help their parents when they finished school.

Choi’s teenage daughter, a third-generation Korean-Canadian, isn’t familiar with the ins-and-outs of running a variety store – no more stocking shelves with instant noodles, no more keeping a wary eye out for shoplifters.

But Choi says the children of immigrants shouldn’t be spared from learning about the sacrifices their parents made to ensure their children would not undergo the same hardships they endured.

It’s one of the reasons she wrote Kay’s Lucky Coin Variety, a fictional, yet deeply personal, account of life in a downtown Toronto convenience store. Mary, the novel’s headstrong, yet conflicted, protagonist, is a composite of Choi and other young Korean women she knew whose stories had yet to be told to a wider audience.

Preserving Canadian history

Choi says she wasn’t ready to pen a memoir for her debut as a writer, but wanted her daughter and other young Canadians to be aware of the Korean-Canadian experience.

“Nobody has gone on to inherit the store, and if I [didn’t] write this story, this whole history would be lost,” says Choi. “This is a part of Canadian history.”

The Choi family moved to Toronto from South Korea in 1975. Choi’s parents worked miscellaneous jobs before saving enough money to buy a variety store on Queen Street West.

What distinguishes the immigrant experience of Koreans, says Choi, is that they had to bounce from neighbourhood to neighbourhood to compete in the convenience store market. Owning a mom-and-pop shop was unlike having a restaurant, which could exist alongside others on the same block.

“We were scattered all over Toronto. We got to experience and live in every pocket,” says Choi. “It gave us insight into Toronto on a bigger level . . . And in some ways, it helped us integrate.”

They led a somewhat “nomadic” life. Moving was dictated by the rising and falling fortunes of the family business.

[quote align="center" color="#999999"]“It gave us insight into Toronto on a bigger level . . . And in some ways, it helped us integrate.”[/quote]

Mixing family and business

The store demanded so much of the family that Choi says it was like their “baby.”

Looking after the store barely gave them time to unwind together. There were no family dinners and no socializing until after the convenience store closed at midnight.

“We were all very aware that we needed the baby to thrive because our success depended on it,” she says.

It was only when she became a mother herself that Choi says she fully appreciated the courage and nerve it took her mother to run a store that was always at risk of being robbed.

“It’s hard not to be resentful [growing up], but looking back, I realize she must have been so afraid, but she didn’t show it,” says Choi.

[quote align="center" color="#999999"]The store demanded so much of the family that Choi says it was like their “baby.”[/quote]

Taking on taboo topics

At a Toronto Public Library event organized as part of its eh List Author series, Choi recalls how she came to write the book, which explores the relationship between mother and daughter.

It took a little nudging from a former student back in 2007, says Choi, who works as a high-school guidance counsellor. She explains how he flipped the question about his ambitions back at her and persuaded her to fulfill her dreams.

“I told him I wanted to write a book, and he challenged me to do that,” she says.

For five years, she would write after her family went to bed at night. “It seemed safer to delve into the Korean psyche when it was quiet,” she says.

She took several writing courses, eventually graduating from the University of Toronto’s creative writing program in 2012. Her final project, Kay’s Lucky Coin Variety, was presented before a literary panel and earned the attention of renowned editor Phyllis Bruce, who acquired the novel for Simon & Schuster.

What struck her editor, Choi explains, was that the book tackled themes of depression and anxiety from the perspective of a Korean-Canadian.

As universal as people’s struggles with mental health issues are, for Choi and other Korean women she interviewed, such anxieties were rooted in a deep resentment toward their mothers. They were seen as an “obstacle” to their desire to be Canadian.

Although aspects of Korean culture have become mainstream, literature still lags behind K-Pop and kimchi in popularity.

This is what partly led Wai, a Chinese-Canadian immigrant, to Choi’s library reading.

“I’m interested in literary diversity,” she says. “I’d like to hear about the Korean experience. Most of it is a universal theme, but it would be nice to hear different perspectives.”

Choi hopes her book will open up the space for other Korean writers who are reluctant to share their experiences.

“There’s a little bit of fear,” she says, adding there are things that Korean Canadians as a cultural group do not discuss.

“We’re very guarded about sharing pain. It’s one thing to share music, food, but stories are so intensely personal.”

Café Babanussa is a story about mental illness that has never been told before. Through the journey of a young, mixed-race woman exploring Germany in the 1980s, we see how mental instability creeps into the lives of even the most beautiful of characters.

The book’s author, Karen Hill, had her own struggles. She was unable to maintain a nine-to-five job due to challenges with tasks such as getting dressed, arriving at work on time, and dealing with co-workers. She neglected work, which led to her living in poverty and having to survive on welfare.

Eventually, she took on creative hobbies such as cooking, art and poetry. As a poet, she became known for her work “What is my Culture?” and “A Breath for you.”

Café Babanussa mirrors Hill’s life and she debated making it a memoir. She wrote the novel – her first – from 1989 to 2012.

As a child, the book's main character, Ruby, had reoccurring dreams of a man smothering her that continued to plague her into adulthood. She would write in her diary, lock herself up in her room, and argue with figments of her imagination.

Now a young adult, Ruby’s need for freedom and independence takes her to Germany, where her past demons and current insecurities intermingle to wreak havoc on her mind and personal relationships.

[quote align="center" color="#999999"]“She became entranced listening to all their voices, searching for some truth in their words.”[/quote]

She explores West Berlin and nearby France. A young man named Werner, a British friend named Emma, and a mysterious drug dealer named Dom – Ruby seeks acceptance from them in a time of racial tumult, as well as an escape from the growing turmoil in her mind.

After becoming pregnant and not knowing whom the father of her child is, Ruby has an abortion that takes a toll on her mind and body. Dom dies from a drug overdose, leading Ruby to slip deeper into depression. Hill described this process as a form of self-isolation.

“Ruby was beginning to slowly lock herself up inside her mind. More and more people were prying their way into her head talking to her,” Hill wrote. “She became entranced listening to all their voices, searching for some truth in their words.”

Ruby later finds out that her mother also dealt with mental illness. Hill reflected on this aspect of Ruby’s life in an essay included at the end of the book. She wrote about mental health problems in her own family and described her personal experience with mental illness as “being crazy.”

A short reprieve

Towards the end, we learn the significance of the book’s title. Café Babanussa is a haven where Ruby and her friends go to escape their stressful lives. At the café, she finds solitude for the first time and comfort in being unapologetically Black and ultimately, herself.

“She felt grateful for having been accepted into the club,” Hill wrote. “The feeling of belonging to one race as opposed to none empowered her.”

[quote align="center" color="#999999"]At the café, she finds solitude for the first time and comfort in being unapologetically Black and ultimately, herself.[/quote]

At Café Babanussa, Ruby meets a new lover, Issam, and becomes pregnant again. She later gives birth to a child and moves back to her parents’ home in Toronto. Her adventure is over, yet her internal struggles continue.

“The architecture in Toronto seemed so bland – new and ugly,” Hill wrote. “[A]lmost every night she went to sleep crying for what she no longer had [and] for weeks she wrestled with dark clouds that seemed to follow her wherever she went. She was tired and listless.”

Understanding a common illness

What makes Ruby’s story so relatable is the fact that we are all familiar with the places that Ruby has encountered on her journey to adulthood. Trying to be encouraged and spirited while dealing with responsibilities, social issues, love and growing-up can be stressful.

Hill’s realistic portrayal of someone who cannot cope with these pressures provides a better understanding of mental illness.

[quote align="center" color="#999999"]She showed that it is easy to succumb to the bullying thoughts, fears, and demons many of us confront.[/quote]

She did not identify Ruby’s illness as a rare and isolated occurrence, but as a struggle that people often encounter in life. She showed that it is easy to succumb to the bullying thoughts, fears, and demons that many of us confront.

Before her death in 2014, Hill wrote a letter that talked about her lonely walks, physically and mentally, which was also included in the book. After being out of institutions and hospitals for three years, she had sympathy for those who remained locked-up and suffering as victims of their minds.

“I feel I have finally reached a place of some stability. From here I can reach out and become a healthier and more active participant in the mental health and wider communities. Sadly, this is still not true for many others who struggle with mental illness.”

Danica Samuel is a freelance journalist from Toronto. She is a compulsive writer who is constantly searching for new stories on the streets and through social media. Samuel has written for the Huffington Post, New Canadian Media and ByBlacks. She prides herself on her creativity, charisma and provocativeness, while always being committed to content that is memorable, relevant and original.

According to the Canadian Mental Health Association (CMHA), 20 per cent of Canadians will have a mental illness at some point in their lives. Mental illness affects all Canadians indirectly through family, friends or colleagues.

[quote align="center" color="#999999"]Some languages do not even have words for the types of mental illnesses that are commonly diagnosed in the West.[/quote]

Genetic, biological, personality and environmental factors can interact to cause mental illnesses, meaning they can affect Canadians of all ages, backgrounds, and education and income levels. Like other health problems, early and effective diagnosis of mental illness is key to its treatment.

That’s why talking about mental health in a way that is open and accepting is so important – and why immigrants can be at higher risk of not being treated.

More education, accessible services are imperative

A study published in the Canadian Medical Association Journal (CMAJ) in 2011 found that while rates of depression and other disorders were lower for new immigrants than the general population, they rose over time.

Language and cultural differences can create barriers to seeking help. Some immigrants distrust mental health services because they have never had experience with them in their country of origin and are not accustomed to speaking openly about mental health issues. Some languages do not even have words for the types of mental illnesses that are commonly diagnosed in the West.

[quote align="center" color="#999999"]“Immigrants are less than half as likely to get professional help for depression compared to self-identified Canadians.”[/quote]

A study by University of Toronto researcher Tahany Gadalla found “immigrants are less than half as likely to get professional help for depression compared to self-identified Canadians.” Gadalla said there are not enough programs geared towards educating people from different cultures about mental health issues.

Migration and resettlement can also create environmental stressors that contribute to mental health problems. Social and economic strain, social alienation, and discrimination are a few examples of these stressors. Refugees are at higher risk than the general population of developing specific psychiatric disorders as a result of exposure to war, violence, torture and forced migration.

Many of the Syrian refugees who are now arriving in Canada have experienced these types of traumas.

The CMAJ study states “immigrants and refugees are less likely than their Canadian-born counterparts to seek out or be referred to mental health services, even when they experience comparable levels of distress.”

This makes it imperative for Canada to prepare accessible services to support refugees as well as educate them about the importance of seeking help.

All Canadians must be a part of the conversation

CAMH provides resources in languages other than English, and put together a video for Let’s Talk Day that features a truer representation of the Canadians affected by mental illness than the Bell Let’s Talk promo I saw.

Across Boundaries is one of several mental health organizations that support people from ethno-racial communities in Toronto. It shows that there are discussions taking place within newcomer communities, but for some reason these aren’t portrayed in the broader national conversation.

[quote align="center" color="#999999"]For a large portion of Canadians, star power and re-tweets will not change their perception that mental illness is a problem they cannot experience, talk about or seek help to treat.[/quote]

I noticed that the Let’s Talk website features the profile of Rwanda native Michel Mpambara, though he appears more prominently in the French-language campaign, presumably because he is a resident of Quebec.

Each January since 2010, on Let’s Talk Day, five cents for every call and text message sent on Bell's network, as well as every Facebook share promoting the campaign, and every tweet using the hashtag #BellLetsTalk, is pledged towards mental health initiatives in Canada.

This year’s campaign raised over $6 million, which will be donated to research programs and organizations through Bell’s Community Fund.

Despite being accused of glossing over the real obstacles to mental health strategies and failing to support its own employees’ mental health, Bell’s campaign gains popularity each year.

People in the CAMH video acknowledge that simply seeing the words “let’s talk” sends a powerful message about starting a discussion on mental illness.

Let’s Talk has the backing of six-time Olympic medalist Clara Hughes, who acts as the campaign’s spokesperson, as well as comedian Mary Walsh, TV personality Howie Mandel, and singer Serena Ryder. As a social media campaign, it is especially relevant among youth, 10 to 20 per cent of whom are affected by mental illness.

But for a large portion of Canadians, star power and re-tweets will not change their perception that mental illness is a problem they cannot experience, talk about or seek help to treat.

We all need to take responsibility for our mental health – families, schools, employers, governments and media. Television, radio, newspapers, and now the Internet have the power to shape our perceptions of what is normal. A news agency has the added duty to represent the truth.

As one of Canada’s largest telecommunication companies, taking on the responsibility of leading a discussion about mental illness requires Bell to speak to all Canadians in order to make the most impact.

Rosanna Haroutounian is a freelance writer and the assignment editor at New Canadian Media. She studied journalism and political science at Carleton University and now splits her time between Quebec City and Peterborough, ON.

According to the 2015 child poverty report for Toronto, newcomer children, children of colour and children with disabilities are among the largest groups living in poverty. Families that fall into more than one of these groups face even more grim circumstances.

Sean Meagher, Executive Director of Social Planning Toronto suggests that immigrants with non-European backgrounds taking care of children born with disabilities face financial crises often.

“English speaking [people], compared to the significant number of immigrants who are not from that background, are successful in getting jobs and we do have a racially segmented employment market [that] people with coloured skin face.”

Sacrificing to take care of family

Those taking care of someone with a disability often relinquish their own plans, as is the case of Ottawa resident Maryem Hashi (name changed for privacy).

Hashi has three younger siblings between the ages of 22 and 26 years old who all have disabilities. She gave up her university studies and a full-time job to fulfill her responsibilities at home.

Hashi, who moved here from Pakistan, recalls her initial days in Canada, when her mother had to face the ordeal of raising her siblings, without much access to Internet. With difficulty in speaking and understanding English, she had to navigate things like funding, health care and programs that suit the needs of her children.

“My siblings didn’t receive any government funds and didn’t go to any specially designed programs to cater to their needs as my parents were not aware that some services were available,” explains Hashi.

Hashi’s siblings have delayed development, which usually starts showing up after a child is two to five years old. It is a “mild” condition that affects their ability to do things “independently.”

“They tend to forget things easily and [have an] inability to do things on a daily basis like managing money, packing a [backpack], remembering directions, etc. and the challenge is to keep them in conversation,” shares Hashi.

Today, Hashi is a program assistant and works part-time in occupational therapy, serving children with disabilities under the age of three to five years old.

What happens after 21 years old?

For Hashi’s siblings, a crucial time came when they each turned 21, as that is the cut-off age for school programming for kids with a disability.

“Due to the lack of government funded after school programs, people with disability after 21 years of age usually stay at home as there is a long waiting [lists] to get into programs suitable to their needs,” says Hashi.

[quote align="center" color="#999999"]"[P]eople with disability after 21 years of age usually stay at home as there is a long waiting [lists] to get into programs suitable to their needs.”[/quote]

She says that such programs are a support for caregivers too, and allow the young person not to lose what they have learned from school.

“My siblings [have been] home for a couple of years, and [are] alone with depression and low self esteem; it’s hard to deal with their ordeal,” she shares. “If we take programs privately, it starts at $90 a day, which is unaffordable with multiple siblings [with a] disability.”

Rabia Khedr, executive director of the Canadian Association of Muslims with Disabilities, runs a program in Mississauga, Ont., DEEN (Disability Empowerment Equality Network) support service, which is an extended-hour day program and works on the capacity building of individuals with disabilities who have aged out of school programs.

“It will be an 8 a.m. to 8 p.m. program,” explains Khedr, “and gives enough time range to caregivers – particularly those who are striving to earn.”

The school has a sliding scale fee structure and the rest is fundraised through charitable donations.

In the long run, Khedr is planning a residence service, especially for people with disabilities who do not have caregivers. She shares that inOntario alone 12,000 people with intellectual disabilities are waiting for housing.

Khedr’s extension of the school in Ottawa, where Hashi will provide some of her services too, is at the initial stage and individuals with disabilities will get three hours of activities on Sunday only starting in the new year.

[quote align="center" color="#999999"]"[W]e want at least medication to be cost-free for all.”[/quote]

Making ends meet

Every year on Dec. 3 is the International Day of Persons with Disability. Thetheme in 2015: Inclusion matters, access and empowerment of people with all abilities.

According to the department of finance, in 2011 the Canadian federal government transferred almost $4 billion to low-income families and spent $19.9 billion on Employment Insurancebenefits alone.

Still for some, medications, dental care and eye check-ups are not included. And in the cases of people with disabilities things like electronic gadgets, crutches, wheelchairs and scooters to assist in daily life are also not fully covered.

“They have to hire special vans to take these individuals from place to place. This all has a cost,” says Hashi. “And we want at least medication to be cost-free for all.”

Khedr says that people who don’t have the experience of poverty won’t understand how choices can become increasingly limited when a person is on welfare assistance.

She suggests, “The solution lies in a combination of a few hours of activity and government funds.”

When Syrian refugee children arrive in Canadian classrooms for the very first time, the anxiety they feel might be more than simply first-day-of-school jitters, say humanitarian relief workers and health-care providers.

Many may be experiencing the trauma of loss and displacement after months, if not years, of being out of school. Despite this stress, heading back to class is the best course to establishing a sense of normalcy, says Patricia Erb, CEO of Save the Children, a global humanitarian agency.

"The children have gone through incredible trauma. They've seen people die, their schools being bombed," says Erb. "Getting into a school is getting back to a normal life. That's what they beg for.”

The role of psychosocial programs

Ontario is expected to absorb about 4,000 of the 10,000 refugees expected to arrive by year's end. The federal government plans to resettle 25,000 Syrian refugees across Canada by February 2016.

Nearly five years into the Syrian conflict, as many as 2.2 million children are living as refugees, with limited access to education and psychological support. In a recent report titled Childhood in the Shadow of War, Save the Children says that one in four Syrian refugee children are at risk of developing a mental health disorder.

Psychosocial programs, which can involve art or play therapy, have helped children make sense of what happened and build their resilience, says Erb.

[quote align="center" color="#999999"]"The children have gone through incredible trauma. They've seen people die, their schools being bombed."[/quote]

And yet these initiatives often receive the least funding, as resources in host countries are stretched thin, says the report.

In tents reserved as safe spaces for children at refugee camps, Save the Children runs activities where the children are asked to draw or dramatize their experiences. Their sketches can provide a glimpse into their emotional state.

"In their drawings, there's blood, body parts that are separated," she says. "You see the war."

The impacts of trauma

While visiting a refugee camp in Jordan, Erb was struck by the behaviour of three- and four-year-olds. "They were coaxed to eat their snacks, but they just wanted to put it in their backpacks. They had that memory of not having enough food."

The stress of poverty — of seeing their parents unable to work, living in informal settlements — is cited in the report as being the primary source of their psychosocial distress. In some cases, children become prone to aggressive behaviour and substance abuse, the report finds.

Trauma manifests itself in different ways, and for children, their somatic (physical) symptoms are more pronounced than with adults, says Dr. Tony Barozzino, a pediatrician at St. Michael's Hospital in Toronto.

"The emotional, psychological symptoms of PTSD (post-traumatic stress disorder) are being experienced or seen as physical symptoms," he explains. "[There's] abdominal pain, chronic headaches, school refusal, which is an underlying sign of significant anxiety, [and] nightmares."

Depending on the severity of their distress, kids may be referred to psychiatrists for evaluation, counselling or medication therapy, he says. Barozzino's colleague, psychiatrist Dr. Morton Beiser, is piloting a program for refugees based on Narrative Exposure Therapy (NET), which was developed in Germany 25 years ago to treat PTSD.

The program, Lending a Hand to Our Future, which will run in eight clinics in Toronto, is suited for children and youth, between the ages of seven and 15. It involves eight to 10 sessions, lasting about an hour, led by trained volunteers in the health-care field. NET is billed as a way for patients to recover their identity.

"They're literally walked through their migration story," he explains. "It helps them understand the situation, get rid of the internalized stress that comes from that. [. . .] It has a very good response rate and very few individuals require further treatment.”

Supporting children at school

What's crucial is for health-care providers, educators and social workers to look out for symptoms, so children who are suffering can be referred to appropriate services, says Barozzino.

The Toronto District School Board (TDSB) is working to anticipate Syrian children’s needs by linking with community partners to outline programs to ease the transition. That includes tip sheets for teachers on class activities, advice on dealing with potential stressors and plans to hold lunch-and-learn sessions.

"You don't want the kids to feel like they have a broken wing," says Marcia Powers-Dunlop, interim senior manager of professional support services at TDSB. "So you want to have as many normalizing activities as possible."

Amid all the anticipation surrounding the children’s arrival, many Torontonian schoolchildren are eager to find ways to relate to their new classmates. Some wonder if they can bring toys to share. Others want to know if it's appropriate to ask about their experience.

"Some kids struggle to think that they're kids just like them," says Powers-Dunlop. "I say, 'They're boys and girls like you. They have the same fears, the same hopes, the same joys.’"

“[We’re] looking at issues like settlement, housing and mental health,” Caulford says, noting that his volunteers are hoping to increase the hours they work, as well as operate a clinic on Saturdays.

“We have a shortage of providers as it is. We are trying to ramp up our volunteers.”

[quote align="center" color="#999999"]“We don’t know the level at which these individuals are going to be injured, traumatized, wounded, sick or unhealthy.”[/quote]

So far, nurses, midwives, pediatricians and social workers have offered to assist the influx of refugees coming to Canada. Medication such as antibiotics has also been donated to help with the effort.

“We don’t know the level at which these individuals are going to be injured, traumatized, wounded, sick or unhealthy,” Caulford says, noting that he’s seen refugees with bullet wounds and deformities as a result of being shot.

“I think [the best thing] for children and youth new to Canada is to have their full family unit together and to get those kids into playgrounds and schoolyards as soon as we can, so they can kick a soccer ball and not run away from a bomb,” he says.

“That’s been shown to be one of the healthiest things you can do for mental health and post-traumatic stress disorder. It’s to get them playing with the other children.”

[quote align="center" color="#999999"]“[T]his is going to make us better at managing surge issues and managing increasing demands within the health-care system.”[/quote]

But while he and several volunteer medical professionals are busy prepping for refugee arrivals, Caulford concludes that the stress of it all will ultimately benefit Canada’s health-care system in the long run.

“We think this is going to make us better at managing surge issues and managing increasing demands within the health-care system,” he says.

“It’s going to teach us of other surges that are to come [and teach us] how to organize ourselves better.”

WelcomePack Encourages Canadians to Welcome Newcomers

Something as simple as saying “hello” is all it takes to welcome a newcomer to Canada.

The e-card showcases the beauty of the Canadian landscape, people and values. It also has a poem encouraging newcomers to experience Canada’s national parks and cultural events.

Along with the e-card, newcomers will also receive a free WelcomePack gift box that includes a guide giving them tips on how to settle in a new country among other items.

[quote align="center" color="#999999"]Something as simple as saying “hello” is all it takes to welcome a newcomer to Canada.[/quote]

“We meet many newcomers to Canada in our community, our workplace and at social engagements,” says Andrew Srinarayan, vice president of WelcomePack, in a press release.

“Through this act of friendship and hospitality, let us reach out to make them feel welcome in their new home country and make a new friend.”

Young Immigrants Achieve Higher Success Rates in School

Immigrant students have a higher success rate in education, according to a study by Statistics Canada.

The study takes a look at the education rates in regions across the country, including Ontario, Quebec, Alberta, British Columbia, Manitoba, Saskatchewan as well as the Atlantic provinces.

In every region, those who immigrated before the age of 15 had high school and university completion rates that were higher than third- or higher-generation Canadians.

In Canada as a whole, 40 per cent of immigrants from the ages 25 to 29 had a university degree in 2011.

Only 26 per cent of third- or higher-generation individuals were in the same group.

[quote align="center" color="#999999"]The lower reading levels likely reflect the fact that neither English nor French is the first language of many immigrant students.[/quote]

The study also examines the regional differences in the reading and math skills of immigrant children aged 15. The Programme for International Student Assessment (PISA) measured these stats between 2000 and 2012.

At the national level, immigrant students scored similarly in math, but had slightly lower reading scores than third- or higher-generation students.

The lower reading levels likely reflect the fact that neither English nor French is the first language of many immigrant students.

But while immigrants were more likely to have degrees in all provinces, there were differences among the regions.

British Columbia had the highest proportion of immigrants with a university degree in 2011 at 44 per cent.

The university completion rates of immigrants were lower in the combined region of Manitoba and Saskatchewan (29 per cent) as well as in Quebec (32 per cent). (Photo Credit: Leland Francisco via Flickr CC)

Immigrating to a new country can put a strain on a person’s mental health and well-being. Art therapy, one of the disciplines being recognized in November as part of arts and health month, can have positive benefits for newcomers’ mental health.

“Moving to another country can be an exciting experience, but it can also be nerve-racking or sad,” explains art therapist Debbie Anderson. “Art making can help people find the inner peace that they may have lost in the migration process.”

According to Arts Health Network Canada (AHNC), arts and health is an interdisciplinary field that embraces different forms of art to promote health, prevent diseases and enhance health service delivery. There are multiple arts and health initiativesavailable across Canada.

AHNC’s communications coordinator, Zara Contractor, mentions that the World Health Organization (WHO) defines health as an individual's complete physical, mental, social, emotional and spiritual well-being, and not only as the absence of disease.

“The arts can positively impact all these dimensions in different ways,” Contractor says.

Contractor highlights the importance of making a distinction between expressive or creative arts therapies from other arts and health practices within the field.

Expressive art therapy focuses on art making as a therapeutic process, while other arts and health practices focus on engaging people in the arts for reasons such as enjoyment, education, distraction from illness, social connection and self-exploration.

Different materials and techniques, such as colouring, painting, collage, clay and weaving are used in expressive art therapy.

[quote align="center" color="#999999"]“People may think that they are not artists, but everybody can use art as a means of expression.”[/quote]

Moreover, expressive art therapies are regulated by professional associations and require a postgraduate or master’s degree.

Tzafi Weinberg, CATA’s advocacy chair, explains that emphasis is placed on safety, confidentiality and unconditional acceptance in a non-judgemental atmosphere throughout the whole therapeutic process.

She adds that the focus of the therapy is not the final product, but the creation process instead. For this reason, no previous experience in art is required.

“People may think that they are not artists, but everybody can use art as a means of expression,” says Jannika Nyberg, co-founder of ArtQuake, a grassroots organization that connects young people through the arts in Vancouver.

The sessions in art therapy can be individual or in a group. While some people can feel more comfortable in individual sessions, group sessions can contribute to creating a sense of community and allowing interaction with people from different backgrounds.

[quote align="center" color="#999999"]“Art has allowed me to express my longing for my family and my country, and to explore my journey and my identity.”[/quote]

According to Anderson, group sessions can be particularly beneficial for newcomers because by sharing their stories, people discover that they have similar experiences as others, and share attributes of resilience and strength.

Newcomers can bring their own culture into the session through the use of symbols, materials, and images that are familiar to them.

Therapists do not interpret the artwork in this process. Instead, they guide the individuals to find its meaning.

“People are their own experts, they know what they need and all the answers are within them,” says Weinberg.

Hana Pinthus Rotchild, a registered social worker and art therapist working with different populations including immigrants and refugees, explains that this approach allows people to recreate the reality they left behind and process any grief or anxiety they may be experiencing.

“Art has allowed me to express my longing for my family and my country, and to explore my journey and my identity,” she shares. “It has also been an avenue to cope with my losses, separations, and transitions, while helping me to stay connected with my roots.”

Non-verbal methods of expression

People of all ages suffering from different conditions like depression, grief, anxiety, trauma and eating disorders can benefit from art therapy.

Anderson explains that this is possible because non-verbal methods can be effective in helping people express themselves.

By encouraging individuals to make art instead of talk about their own emotions and ideas, art therapy can provide gentle, healthy and positive communication outlets and coping mechanisms.

[quote align="center" color="#999999"]“In art therapy, people can express through their own visual voice without the need of words.”[/quote]

“In art therapy, people can express through their own visual voice without the need of words,” says Pinthus Rotchild.

Naimi explains that once people express what cannot be said through other mediums, they find relief, process their experiences, improve their self-esteem and envision the future they want for themselves.

“Art is the one place where I can get out of my mind and into my body to express and process my emotions,” she says. “If I didn’t have that outlet, I don’t know where all those emotions would have gone.”

Scholars and students recently gathered at Canada’s top health education institute to discuss racial health inequities experienced by immigrants, refugees and racialized groups.

The eighth annual Dalla Lana student-led conference titled Racial Justice Matters: Advocating for Racial Health Equity took place at University of Toronto’s (U of T) Dalla Lana School of Public Health this past weekend.

Approximately 200 undergraduate and graduate students from U of T, along with academics and researchers, health policymakers and members of immigrant community agencies were in attendance.

The goal was to share trans-disciplinary thoughts and solutions to achieving racial health equity in the Greater Toronto Area. The organizers hoped the conference could shift the conversation in public health by reframing racism as a public health issue.

[quote align="center" color="#999999"]“We chose this theme for our conference because of the staggering inequities faced by racialized individuals in Canada that not only affect their social outcomes, but health outcomes as well.”[/quote]

“We chose this theme for our conference because of the staggering inequities faced by racialized individuals in Canada that not only affect their social outcomes, but health outcomes as well,” says Anjum Sultana, one of the co-chairs of the conference and a student in the masters of public health program at the Dalla Lana School.

Dr. Lin Fang, one of the conference’s speakers held a session titled “Culturally Responsive Mental Health Services for Racialized Groups”.

She shared that despite how important “culturally competent” services are to immigrant communities the government still worries that branding services as such will discourage social service inclusiveness.

“It’s scary (to them),” she admits.

Fang, an associate professor at University of Toronto, specializes in mental health services for immigrants, refugees and racialized groups and is also the board chair for Hong Fook Mental Health Association, a community agency that has served East and Southeast Asian communities for three decades.

Immigrants are not immune to suffering from mental health issues, explains Fang.

“[Just over six per cent] of immigrants [have] had at least one major depressive episode,” says Fang, “[and] 0.5 per cent of immigrants reported experiencing problems related to alcohol dependence. First- and second-generation immigrants were at elevated risk for psychosis.”

[quote align="center" color="#999999"][D]espite how important “culturally competent” services are to immigrant communities the government still worries that branding services as such will discourage social service inclusiveness.[/quote]

And while suicide rates for the immigrant population were about half of those of the Canadian-born, psychological distress, post traumatic stress disorder and depression are high in refugee groups, Fang continues.

“New immigrants and refugees are also less likely to seek out and be referred to mental health services, or use less services,” Fang indicates, explaining that language barriers, inadequate time and fractured support networks all contribute to such a reality.

In Hong Fook’s annual report one of its clients describes how such services helped:

“During the Lunar New Year, I was back to square one with my depression. I did not pick up the phone at all, and my mental health worker ended up paying me an unscheduled visit, and helped me to connect with my family. She knows my culture and the meaning of the Lunar New Year for me, and I value her support a lot,” the client said.

A large part of post-migration stress can be tied to income. For example, in Toronto, the poverty rate of some immigrant groups – 69.5 per cent for the Somali community, 27 per cent for the Tamil community and 56 per cent for the Afghan community – is much higher than the city’s 17 per cent average.

[quote align="center" color="#999999"]"[W]hat we really want to do is find an institutional solution to improve our responses to aboriginal and indigenous people, immigrants and refugees.”[/quote]

Poverty is often linked to unemployment and underemployment. Unemployment is 30 per cent higher for immigrants than for those who are Canadian-born.

Not to mention, many immigrants arrive highly educated, but are forced to work in unrelated ‘survival’ jobs just to make ends meet due to a lack of Canadian experience or their foreign credentials not being recognized.

Next steps

“[The results of this conference] will definitely not disappear,” promises Meena Bhardwaj, co-chair of the conference and also in her second year of the masters of public health program at Dalla Lana.

“We have a website. Every single talk will have notes that will be available online. We also have some forward direction that we will take after the conference.”

Sultana adds that Toronto is well positioned as a city in which real change can happen.

“After the conference, what we really want to do is find an institutional solution to improve our responses to aboriginal and indigenous people, immigrants and refugees,” she says. “We are going to ask our faculty here to start pushing forward.”

Moving to a new country can be stressful. It means leaving familiar places, people and aspects of everyday life behind. Whether arriving in Canada with their family or alone, adjusting to a new and unfamiliar environment for many newcomers is difficult.

Volunteering and getting involved in social activities has helped many adapt, and had positive effects on their overall well-being.

Originally from Pakistan, Shahnaz Ali, 44, lived in Saudi Arabia and the U.S. before coming to Canada in 2002. Encouraged by the principal, Ali began volunteering at her daughter’s school, and then later with the YMCA and a Sunday school.

She remembers the value of volunteering during those early days in Canada.

“Newcomers can get the opportunity to socialize and meet new people and get a better understanding of Canadian culture,” says Ali, who now volunteers with The Ottawa Hospital.

[quote align="center" color="#999999"]“Simply put, it feels great to give back to others through volunteerism, plus there are opportunities to develop new skills.”[/quote]

Sherri Daly, manager of volunteer resources at The Ottawa Hospital, describes volunteering as an effective way to learn about social norms in Canada.

“It is vital to get out of your house when you are new to a community or job hunting. Having meaningful things to do can be a way to build self-esteem and connections,” says Daly.

Gaining valuable work experience

Having local work experience may be vital when looking for new employment. In such a situation volunteering can be beneficial, explains Annmarie Nicholson, director of volunteer services at The Royal, a mental-health research and care facility in Ottawa.

“Simply put, it feels great to give back to others through volunteerism, plus there are opportunities to develop new skills,” says Nicholson. “Work experience as well is a very practical benefit to volunteering, and having a local reference person when applying for jobs is a big benefit as well.”

Besides learning about Canadian culture and creating new resume material, being active is a chance to help others, adds Andrea Tatarski, coordinator in humane education at the Ottawa Humane Society.

“Volunteers have the opportunity to give back to the community by making positive differences for the animals in our care, as well as the people we serve through our various programs and services.”

Improving mental health

Sinthuja Krishnamoorthy works in the Newcomer Youth Program at East Metro Youth Services, an adolescent mental-health and addictions centre in Scarborough, Ontario.

[quote align="center" color="#999999"]Some newcomers may be interested in volunteering, but are unsure of where to start or are hesitant to get involved.[/quote]

The program is geared toward engaging young refugees and those who have permanent residency in Canada in social and volunteering activities.

“Becoming lonely in a new country and being away from family can cause anxiety,” says Krishnamoorthy. “We help these newcomers discuss their issues in a safe environment.”

The biggest challenge for youth is often feeling confident in their language skills, Krishnamoorthy explains.

“They might not learn English as a second language in their home countries, or aren’t comfortable using it. This is where our daily conversations and interactive activity component comes in handy.”

Once program participants feel more comfortable, Krishnamoorthy says they have an opportunity to volunteer.

Participants have made mattresses from used milk bags to send to developing countries, for example.

“We want to keep youth active and interested,” says Krishnamoorthy. “We ask the youth what they would like to achieve by being in the program.”

Krishnamoorthy also has success stories to share. “One youth was shy at the beginning, but now he is going into his second year of medical school. Another young man [shared] in a television interview his understanding of what mental health is. [He said] speaking of it and seeking help has greatly improved his relations with his family and helped to improve his own mental health.”

Taking the first step

Many things may prompt a person to decide to volunteer.

[quote align="center" color="#999999"]“I believe volunteering my time is the best way [to] appreciate all blessings in my life.”[/quote]

One reason might be positive encounters with a particular organization.

“I had a friend who had a very good experience with the nursing staff when her father stayed at [The Ottawa Hospital], and she committed to volunteer to give something back to the cause,” shares Ali.

For others, the decision to start volunteering may arise from a personal situation.

“I lost my hearing about six years ago, and as that happened, my employer refused to accommodate my disability,” says one volunteer from The Ottawa Hospital who wishes to remain anonymous. “Volunteering at the hospital allows me to gain experience so that in the future I can find an employer who will accommodate [me].”

Some newcomers may be interested in volunteering, but are unsure of where to start or are hesitant to get involved.

Nicholson says that the best time to start is now.

“Facing all of the massive changes you have already faced through immigrating to our country has allowed you to build resiliency you may not recognize,” she says. “Share your concerns honestly with the agency you are considering volunteering with, and that agency will find ways to overcome the barriers that are contributing to your hesitancy.”

Says Ali: “I believe volunteering my time is the best way [to] appreciate all blessings in my life.”